Can student administer medication without RN supervision?

[AnneN]

Is it possible (legal) for a student nurse to administer medication without supervision of the preceptor nurse or the clinical instructor?

I know it happens all the time, and often if the student makes a mistake, she is severely penalized.

I am wondering whether it is possible for the hospital, preceptor nurse or clinical instructor to allow the student nurse to administer medication without providing supervision through every step of the way.

I was told by someone that it is illegal (against Nurse Practice Act in most states) for a student to administer medication even if it is P.O., and that an RN must be with the student through every step of the process.

Is this true? Is this law different from state to state? Or is this pretty much the same in all states?

[~Mi Vida Loca~RN, ASN, RN]

Depends on your state. In CA, there is a provision in the Nurse Practice Act that allows nursing students currently enrolled in a program to perform "nursing duties"- including passing medications. I've quoted it in an earlier post.

No one works under anyone's license- we've addressed this above. However, as the RN assigned to that patient, you do retain responsibility for their care.

Mi Vida Loca- I'm not saying that the way your school did it was wrong or that you didn't get good experience, much to the contrary, sounds like you had excellent clinicals. But schools are different, and as long as we are safe in our practice and learn to become (hopefully) excellent nurses with high standards, I think that there are accounting for differences in permissiveness. Assuming, of course, that no regulations and/or policies are being violated. Have a great vacation!

I understand schools are different.I can't believe how different some schools are regarding a lot of things. But I read stuff on here all the time that amazes me. I was simply stating my opinion on it, which I am entitled too. Some people feel things are safe and I don't agree. At the end of the day the only thing that matters is that school, state and hospital policy's are followed. People in this thread have seemed to get offended by the thought of students having to be supervised but then they go on to put down a program or how the students will turn out when a program differs from theirs. it's a little hypocritical IMO (not saying. You specifically did this) I really did have a great clinical experience and got pretty much the full feel of being the "nurse" In the last year.

Anyway thank you on the well wishes for my vacation. It is well deserved!!

Good luck to you too in your future ventures.

[studentinnursing]

And I must say, when I am an RN, I would never let a student pass meds without my watching, pulling,passing, etc. Completely hipocritical, but I just wouldn't be comfortable with that. On the other hand, when oir school came in and I know how they do things, instructor/students hold MAR because instructor's license is what those meds are being passef under, I will still have a hard time. Maybe I feel that way because I ama syudent with no experience right now and fe I need to know evrything that's going on with my patients at all times, and I have not haf more than 2 patients at one time, so I can go through charts.....I hope I can always remember what it is like to be a student. Our instructors also know a lot of the RNs that we do our clinical with on any given day, so they try to pit us with an RN who will let us (want the help) put in catheters, take over the 4 piggybacms they need ovet the next 4 houts....that kind of thing; each semester I have had that...our insyructir will put us with the RNs who will let us do anything within our scope and most RNs will stay in the room. When it's our dau to do meds, it is up to them whether they watch or not brcause the responsibility is on them "legally" and I believe ethically and morally the responsibility is on me, so I never take the shortcuts I see happen every fay, NEVER, because in my mind I am responsible for my patients--legally it's gonna comr back on yhe instructor too, but I plan to take all responsinility of anything that is within my scope and/or that I have fone. Since my scope of knowledge is 1 year of nusring school, vontinuity of care is not possible without someone with full nursing knowledge overseeing the patient. Meds areone little bit step in a shift of taking care of a patient. I hope I can be a little more flexible when I am an RN with a student than I think I will...

[melmarie23, MSN, RN]

while in school, we were allowed to give PO meds without supervision. however, we always had to have a RN or our CI sign them out of the pyxis for us.

once I got to my practicum and was on my own with just a my preceptor...she watched me give my first few IMs/SQs and hang piggy backs and other IV fluids and once she deemed me confident enough, allowed me to go in on my own to do these. But of course, she always had to be there for me to remove from the med room and we'd review the meds there if need be.

[~Mi Vida Loca~RN, ASN, RN]

while in school, we were allowed to give PO meds without supervision. however, we always had to have a RN or our CI sign them out of the pyxis for us.

once I got to my practicum and was on my own with just a my preceptor...she watched me give my first few IMs/SQs and hang piggy backs and other IV fluids and once she deemed me confident enough, allowed me to go in on my own to do these. But of course, she always had to be there for me to remove from the med room and we'd review the meds there if need be.

Yeah practicum was the only time our policy changed. It was up to the preceptors decision. But in a way that didn't matter because the way the emar was at the hospital I was at, when I scanned all Meds and checked it off a Screen popped up for the co-signers verification which had to be the other nurse. The hospitals policy was an RN had to be present. The other hospital I was at for clinicals didnt have that but the students were very limited on what they could chart so when we did Meds we had to be signed in under the nurses count to scan and administer. None of the hospital or schools policies mattered if it was PO or not though. It was a general policy covering all Meds.

[redhead_NURSE98!, ADN, BSN]

There seems to be a reading issue going on and a gross exaggeration of what I did in fact say. But if you need something clarified I would be more then happy to clarify it when the discussion can be communicated in an adult manner without all the twisting of words and added exaggeration that seems to be added to all of your replies to me.

I'll pass on requesting clarification from you. If they're just a body in the room watching you then they're unnecessary and we have the same nursing program in the end. That's the point. And to call anything else unsafe without knowing the entire story as someone else on here did (and probably you, but I don't care to read post upon post of the same thing over and over again) is a touch short sighted. I can understand a nurse wanting to protect their license from a student who is a stranger to them. I can't understand someone acting like their presence in the room is necessary and it is unsafe any other way. There is such a thing as an instructor knowing their students and their experience level, and how much you can let some of them go and how much some of them need to be highly supervised. In a program with an instructor to every 5-6 students in the same unit, it's not that big of a deal, I promise. Our nurses aren't cringing in fear of a student passing their Lortab and hanging their Protonix drip without them standing in the room.

[CrazziiRN913, ADN, BSN]

At my school your not suppose to but when you put 8+ students to 1instructor...sometimes the instructors let certain student go pass meds they feel they are capable of passing them selves.

[sweetiepeas]

At my school, in the second year we are able to give all PO meds (including narcotics) and insulin/heparin (once the dose is witnessed we give it). We do not have to have an RN double check or be in the room. At the beginning of the quarter we take a math test and also get checked off by our instructors. The only thing an RN has to be there for is anything IV.

[~Mi Vida Loca~RN, ASN, RN]

I'll pass on requesting clarification from you. If they're just a body in the room watching you then they're unnecessary and we have the same nursing program in the end. That's the point. And to call anything else unsafe without knowing the entire story as someone else on here did (and probably you, but I don't care to read post upon post of the same thing over and over again) is a touch short sighted. I can understand a nurse wanting to protect their license from a student who is a stranger to them. I can't understand someone acting like their presence in the room is necessary and it is unsafe any other way. There is such a thing as an instructor knowing their students and their experience level, and how much you can let some of them go and how much some of them need to be highly supervised. In a program with an instructor to every 5-6 students in the same unit, it's not that big of a deal, I promise. Our nurses aren't cringing in fear of a student passing their Lortab and hanging their Protonix drip without them standing in the room.

There is also such a thing as policy and it must be followed no matter how some inexperienced student feels it is. As a Nurse, I will protect my license first, regardless if I know someone well enough or not.

Just a FYI, I have never given a lortab, my patients were on stronger stuff.

It's also pretty short sighted to think your opinion is the only valid one and to do the very thing you seem to have an issue with in your "debate".

[redhead_NURSE98!, ADN, BSN]

There is also such a thing as policy and it must be followed no matter how some inexperienced student feels it is. As a Nurse, I will protect my license first, regardless if I know someone well enough or not.

Um, what relevance does your policy have to any other facility's policy? We don't have to follow it. You did. We followed our own. They are what they are. It's not really a debate. No one debated your policy. No one said to ignore your policy. I'm really lost, sorry. I'm afraid I've run out of things to say that might create a cross for you to bear.

It's also pretty short sighted to think your opinion is the only valid one and to do the very thing you seem to have an issue with in your "debate".

Yep that's what I said. My "opinion" is the only valid "opinion."

[shortnorthstudent]

This is a bit off topic, but from reading, it sounds like many of the students here are giving only PO or non-narcotic meds. Those who are giving meds without direct supervision - are you doing things more like passing colace and the like or more along the lines of pushing dilaudid?

As I said before, the hospital I am at requires the med, patient, student and CI to all be scanned at the bedside before giving a medication. So our instructors have to be in the room for med passes. But, we are also pushing narcotics, hanging antibiotics and giving loads of insulin and lovenox shots. I don't know how things will be further into the program, but I am 3rd quarter (out of 7), so basically just finished my 9th month in nursing classes. I will say that my CI will move onto the next student/patient group while I complete pushing a med. She didn't always stay through the entire 5+ minute process of pushing whatever I was giving. I do not know if that's standard of if she would do that only for particular students.

[redhead_NURSE98!, ADN, BSN]

This is a bit off topic, but from reading, it sounds like many of the students here are giving only PO or non-narcotic meds. Those who are giving meds without direct supervision - are you doing things more like passing colace and the like or more along the lines of pushing dilaudid?

As I said before, the hospital I am at requires the med, patient, student and CI to all be scanned at the bedside before giving a medication. So our instructors have to be in the room for med passes. But, we are also pushing narcotics, hanging antibiotics and giving loads of insulin and lovenox shots. I don't know how things will be further into the program, but I am 3rd quarter (out of 7), so basically just finished my 9th month in nursing classes. I will say that my CI will move onto the next student/patient group while I complete pushing a med. She didn't always stay through the entire 5+ minute process of pushing whatever I was giving. I do not know if that's standard of if she would do that only for particular students.

I think it's pretty universal that depending on what semester you are in, you get more freedom to work on your own. First semester I don't think anyone gave even PO meds without an instructor with you. No matter what semester, our instructors always watched you the first time or two and if they were comfortable with you all you'd have to do is go tell them what you needed to give at the beginning of the clinical and answer any questions they have for you (what's it for, what do you need to know about the pt to give the med etc.) The instructor's judgment was at stake at my school, not the floor nurse.

From reading this thread, it all sounds very similar no matter how it's done, or we wouldn't all be passing the same test that will get you a license in all 50 states and managing not to kill people.

[shortnorthstudent]

I think it's pretty universal that depending on what semester you are in, you get more freedom to work on your own. First semester I don't think anyone gave even PO meds without an instructor with you. No matter what semester, our instructors always watched you the first time or two and if they were comfortable with you all you'd have to do is go tell them what you needed to give at the beginning of the clinical and answer any questions they have for you (what's it for, what do you need to know about the pt to give the med etc.) The instructor's judgment was at stake at my school, not the floor nurse.

From reading this thread, it all sounds very similar no matter how it's done, or we wouldn't all be passing the same test that will get you a license in all 50 states and managing not to kill people.

I understand that generally you gain additional responsibility as you progress through your program. What I was curious about were the comments that seem to indicate that in some programs students do not push meds at all, with or without a CI present.